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Digestive Diseases and Sciences

, Volume 50, Issue 2, pp 399–406 | Cite as

Combination Endoscopic Band Ligation and Sclerotherapy Compared with Endoscopic Band Ligation Alone for the Secondary Prophylaxis of Esophageal Variceal Hemorrhage: A Meta-Analysis

  • Hetal A. Karsan
  • Sally C. Morton
  • Paul G. Shekelle
  • Brennan M. R. Spiegel
  • Marika J. Suttorp
  • Marc A. Edelstein
  • Ian M. GralnekEmail author
Article

Endoscopic band ligation (EBL) is the community-accepted standard therapy for the secondary prophylaxis of esophageal variceal hemorrhage. Recent data indicate that combination EBL and sclerotherapy may be a more effective therapy than EBL alone. Yet existing data are conflicting. We therefore performed a meta-analysis to compare the efficacy and safety of EBL and sclerotherapy versus EBL alone for the secondary prophylaxis of esophageal variceal hemorrhage. We performed a systematic review of two computerized databases (MEDLINE and EMBASE) along with manual-searching of published abstracts to identify relevant citations without language restrictions from 1990 to 2002. Eight studies met explicit inclusion criteria. We performed meta-analysis of these studies to pool the relative risk for the following outcomes: esophageal variceal rebleeding, death, number of endoscopic sessions to achieve variceal obliteration, and therapeutic complications. There were no significant differences between EBL and sclerotherapy versus EBL alone in the risk of esophageal variceal rebleeding (RR = 1.05; 95% CI = 0.67–1.64; P = 0.83), death (RR = 0.99; 95% CI = 0.68–1.44; P = 0.96), or number of endoscopic sessions to variceal obliteration (RR = 0.23; 95% CI = 0.055–0.51; P = 0.11). However, the incidence of esophageal stricture formation was significantly higher in the EBL group than in the sclerotherapy group. There is no evidence that the addition of sclerotherapy to endoscopic band ligation changes clinically relevant outcomes (variceal rebleeding, death, time to variceal obliteration) in the secondary prophylaxis of esophageal variceal hemorrhage. Moreover, combination EBL and sclerotherapy had more esophageal stricture formation than EBL alone.

KEY WORDS

meta-analysis esophageal variceal hemorrhage Health Services Research 

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Copyright information

© Springer Science+Business Media, Inc. 2005

Authors and Affiliations

  • Hetal A. Karsan
    • 3
    • 6
  • Sally C. Morton
    • 4
    • 7
  • Paul G. Shekelle
    • 2
    • 4
    • 7
  • Brennan M. R. Spiegel
    • 1
    • 3
    • 5
    • 6
  • Marika J. Suttorp
    • 4
    • 7
  • Marc A. Edelstein
    • 3
    • 6
  • Ian M. Gralnek
    • 1
    • 3
    • 5
    • 6
    Email author
  1. 1.Divisions of Gastroenterology and HepatologyVA Greater Los Angeles Healthcare SystemLos Angeles
  2. 2.General Internal Medicine/Health Services ResearchVA Greater Los Angeles Healthcare SystemLos Angeles
  3. 3.Center for the Health Sciences, Division of Digestive DiseasesDavid Geffen School of Medicine at UCLALos Angeles
  4. 4.RAND HealthLos AngelesUSA
  5. 5.CURE Digestive Diseases Research CenterLos AngelesUSA
  6. 6.Center for the Study of Digestive Healthcare Quality and OutcomesLos AngelesUSA
  7. 7.Southern California Evidence-Based Practice CenterLos AngelesUSA

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